Evolution of the genetic architecture of uterine disorders

Uterine disorders and menstrual abnormalities are prevalent reproductive conditions with significant clinical consequences. Recent genome-wide association studies have identified hundreds of variants contributing to different uterine disorders, while epidemiological evidence suggests that these disorders co-occur more frequently than expected, implying shared genetic mechanisms. However, the specific genetic variants and biological pathways underlying this shared architecture remain poorly characterized. Here, we conducted a uterus-centric, multi-trait genome-wide association analysis across ten uterine disorders in a European cohort to elucidate this shared genetic architecture. Further, we embedded this architecture in a functional and population genomics framework to investigate its plausible biological mechanisms and its evolutionary history in humans. We confirm strong positive genetic correlations between major uterine disorders and identify 31 independent susceptibility loci jointly affecting the genetic risk of multiple uterine pathologies, substantiating an intertwined biological basis. Populational analyses demonstrated that several of these susceptibility variants exhibit pronounced allele frequency differentiation across global populations suggestive of recent polygenic selection, including variants with well-supported regulatory functions at the ESR1-CCDC170, WNT4, SFR1, FOXO1, ITPR1, DMRT1 and CDKN2B loci. Notably, we show that most derived alleles acquired during recent human evolution increase risk across multiple uterine disorders and may evolve under antagonistic selection. These findings provide functional annotation and population-level prioritization of genetic variants influencing multiple uterine disorders. They also highlight how past evolutionary histories may contribute to population differences in uterine disease prevalence and pathogenesis.